by Jamie Moses
I recently went to the DMV to turn in license plates. There were about a dozen Purell dispensers stationed along the service windows which about half the people in the room took advantage of. Every supermarket in town now has Purell dispensers at the entrance and I’ve watched as 100% of those entering, many wearing masks, dutifully rubbed their hands with Purell before shopping. Every local hospital has Purell dispensers stationed at multiple locations. New Purell dispensers are popping up everywhere during this Covid-19 crisis including corner bodegas selling beer and cigarettes.
This is obviously done in a community wide effort to stem the growth of the coronavirus pandemic. The problem is that not only does Purell not protect you from the transfer of pathogens like Covid-19, it can actually make you more vulnerable to the disease. Yet this alcohol-based hand sanitizer is the gold standard for cleaning hands set by the World Health Organization (WHO) and Center for Disease Control (CDC) who each published nearly identical Guidelines for Hand Hygiene.
It’s not surprising the guides are identical. The guidelines for both organizations were authored by the same two people, John M. Boyce, MD, a paid consultant for GOJO Industries who manufactures Purell, and co-author Didier Pittet, MD, also a paid consultant for GOJO Industries. Boyce and Pittet first wrote the guidelines for the CDC in 2002 and then in 2004 the WHO hand hygiene committee “decided to adopt the CDC Guideline for Hand Hygiene in Health-Care Settings issued in 2002.” Boyce was the chair of that committee. Both the CDC and the WHO committees were stacked with people receiving research support, honorariums or were paid consultants for GOJO Industries, Bode Chemical and 3M. They all manufacture alcohol-based hand sanitizers.
After 18 years of promoting this failed solution for hand hygiene the FDA finally stepped in on January 17, 2020 and issued a strict warning letter to GOJO Industries to stop marketing Purell as effective against the transmission of disease because there are no peer-reviewed clinical studies demonstrating the company’s claims. The letter cited numerous examples of false advertising on both GOJO’s website pages and on its Facebook account that “clearly indicate your suggestion that PURELL® Healthcare Advanced Hand Sanitizers are intended for reducing or preventing disease…” It’s possible the rising death toll from the Covid-19 pandemic spurred FDA to act.
The recommendation by the CDC and WHO for alcohol-based hand sanitizers caused its adoption in hospitals worldwide and in the home and many large retail outlets like Walmart. This has been lucrative for GOJO Industries ($560 million a year in revenue).
To understand why this is so dangerous we need to understand some basic elements of hand hygiene.
Hand hygiene is practiced to prevent pathogens being transferred by your hands. A pathogen is a micro-organism that causes disease upon entering your body. According to the CDC, an estimated 80 percent of infections are transmitted by our hands. All a pathogen needs to thrive is a host body. Once the pathogen sets itself up in a host’s body, it uses the body’s resources to replicate and overwhelm the immune system, often leading to the death of the host.
There are four types of pathogens, viruses, bacteria, fungi (vaginal yeast infection, thrush), and parasites (malaria from mosquitos or E. coli from worms). Here we’re concerned with bacteria and viruses. They can be spread through skin contact like shaking hands, bodily fluids like sneezing, airborne particles, contact with feces, and touching a surface touched by an infected person, thereby picking up the pathogen with your hands.
Most states have some level of stay-at-home order in place but allow for essential travel to pharmacies, doctors, gas stations and grocery shopping. The Institute of Transportation Engineers estimates that one Walmart super center receives 10,000 car visits per day, that’s probably 15,000 people going into the store and touching things. Hands transfer pathogens.
A supermarket like Wegmans processes over 5,000 transactions per day, which is probably 7,000 shoppers because many people shop with a friend, lover, spouse or other family member. When your mother or whoever does the shopping squeezes that avocado or peach for ripeness, puts her hands on the shopping cart, grabs the door handle of the cooler with the milk, hundreds of other hands have touched those surfaces, as well. Hands transfer pathogens. How many people touched that gas nozzle you just used at the Mobil station? Hands transfer pathogens. (Gloves also pick up and transfer pathogens when touching surfaces).
Washing your hands with soap and water works to prevent viral and bacterial pathogen transfer. Rubbing Purell on your hands does NOT.
A drop of ordinary soap diluted in water is sufficient to rupture and kill many types of bacteria and viruses, including the new Covid-19 virus. For the science behind soap’s effectiveness read this article in the New York Times “Why Soap Works.” (This article still gives mild but cautionary support to alcohol-based hand sanitizers).
The Purell Problem
Purell contains 70% ethyl alcohol. When alcohol is rubbed on your hands it does two things, exposed to air, it evaporates quickly, and it dries out the skin causing micro cracks in the outer epidermis which invites more infection. Some alcohol-based hand sanitizing products, including Purell, include lotion moisturizers to reduce that drying. Ironically, follow up research showed the lotion inhibits the alcohol from being effective at killing pathogens.
Of course, to justify their conclusions the guidelines that Boyce and Pittet wrote had to examine a few different chemicals before settling on their alcohol-based candidate for hand sanitizing. However, if you read the guide there is a disproportionate promotion of alcohol-based sanitizers. Simply looking at the word count dedicated to each chemical says it all: Soap-184 words; Hexachlorophene-306 words; Triclosan-345 words; Chlorhexidine-374 words. Alcohol-1,780 words.
However, the section promoting alcohol-based hand sanitizers is loaded with caveats that compromise the product and lists several studies that are inconclusive.
I don’t dispute that Alcohol-based hand sanitizers will kill germs the moment it is applied. However, it’s rarely applied in a way to do this effectively and it has no lasting effectiveness.
The guide states “Hands must be kept very wet with sanitizer and vigorously rubbed for 3 to 4 minutes, especially between the fingers and around the nails.”
The average amount of Purell needed to be effective at killing pathogens is 3 millimeters. In reality, people use 1 millimeter of Purell, which is not enough to make the hands “very wet.” Going back to my observations at the supermarket, people put a dab on their hands and gave them a quick rub of less than 10 seconds. That’s very far from the 3 to 4 minutes required. But even if you followed the advice of very wet and prolonged rubbing there is no evidence of prolonged effectiveness. You might kill some pathogens at the moment and then go in the store and pick up a new load of pathogens. The CDC even says hand sanitizers dry up in 20 seconds after rubbing the hands.
An enormous problem created by both of these guidelines that recommend alcohol-based hand sanitizers as the only alternative to soap and water, is that this has made it virtually impossible for any other product to enter the market. In effect the CDC and the WHO have shut out any competition to alcohol-based hand sanitizers.
Remember, cleaning hands is not the objective to preventing disease. The objective for any product applied to the hands for healthcare workers and the public is preventing the transmission of pathogens, but effective products are locked out. For example, I know of a product that uses Benzethonium set in a bioclay-based lotion that prevents pathogens from spreading and it remains effective for several hours. But it’s not readily available in the marketplace like Purell.
As of this writing the United States leads the world in the number of Covid-19 infections and deaths with over 565,000 infections and 23,000 deaths. That’s more than Italy, France, United Kingdom, Germany and Iran combined.
There’s no question that lack of testing and the three months the Trump administration and Fox News spent ignoring, dismissing and even ridiculing the fact the United States had a Covid-19 problem allowed the virus to gain a strong foothold in America. That’s a fact. Here’s a question. Could the number of infections have been reduced if people weren’t running around confidently touching everything because they thought they were protected after applying Purell to their hands?